Wiki Surgeries on 2 different body areas

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joanne71178

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If a patient has surgery on 2 different body areas in one surgical session, is it okay for the Doctor to dictate 2 separate OP notes and bill the surgeries on 2 separate claim forms?

Is this ethical? legal?

Thanks in advance!
 
It is not necessary to send on separate claim forms; use of modifier -59 would be used to denote separate body systems.
 
I am well aware of using Modifier 59. My issue is that one of the Ortho Groups I code for dictate each surgery as if they are performed individually when they are performed in the same surgical session as a surgery on a different body area. I need to know if this is ethical? or any other legalities by posting these charges on 2 separate claim forms? The office makes their appointments and I code and post the charges. They will schedule a different appointment for each individual surgery even when performed at the same session as another case. I recently realized this as I will separate the surgeries by body area, not by patient.
 
joanne71178 said:
I am well aware of using Modifier 59. My issue is that one of the Ortho Groups I code for dictate each surgery as if they are performed individually when they are performed in the same surgical session as a surgery on a different body area. I need to know if this is ethical? or any other legalities by posting these charges on 2 separate claim forms? The office makes their appointments and I code and post the charges. They will schedule a different appointment for each individual surgery even when performed at the same session as another case. I recently realized this as I will separate the surgeries by body area, not by patient.
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I've seen this done both ways, as separate reports, and 2 surgeries same session put in the same note. I'm not aware of any legal or ethical issues for either way, and by doing the 2 reports separately, the surgeon is only creating more work for himself, but I believe that as long as it is being coded appopriately, then it should be fine.

:confused: Hope this helps!
 
Thanks , My concern was that the insurance co. was paying for 2 primary procedures at 100%. Where if the doctor dictated one note and I used the 59 modifier the payments would be less. I wasn't sure if that was allowable.
 
I don't know what procedures are being done, but it seems that if both procedures were performed under single anesthesia at a single operative session by the same physician, one operative report would be more appropriate than 2 operative reports. It just sounds like the way the procedures are being scheduled is causing more confusion on the billing end. I read something about this situation recently. I'll try to find it for you.
 
I definitely agree that this causes confusion. I'd like to clarify my earlier response, by "as long as the procedures are being coded appropriately", I do mean appropriate modifiers to reduce payment for subsequent procedures performed on the same day.
 
2 Op reports OK / 2 claims NO

Having 2 op reports isn't a problem (as long as the coder knows to look for more than one op report).

But if they are performed in a single operative session, they should be submitted on one claim with the appropriate modifiers.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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